MedicaidPrior AuthMedium impact
Provider Announcement
Oregon Health Plan·OR·Plan
Effective date
May 1, 2020
We identified it
Jun 20, 2026
Summary
The Oregon Health Authority has issued discretionary guidance allowing Coordinated Care Organizations (CCOs) to temporarily suspend or modify prior authorization requirements during COVID-19. CCOs may now accept retroactive authorization requests, extend authorization approval dates by 180 days for elective procedures, waive PA requirements for specific medications and DME, and suspend PA for patient transfers to post-acute care settings. These changes are optional but recommended to reduce provider burden and ensure member access to care.
Action Required
By May 1, 2020 and ongoing: Billing team should review whether your practice's CCO payers have elected to implement any of these PA flexibilities. Contact each CCO partner to clarify their specific policies on: (1) retroactive authorization acceptance, (2) 180-day authorization extensions for elective procedures, (3) PA waivers for pharmacist-prescribed medications (birth control, Naloxone), (4) PA waivers for COVID-related DME from inpatient discharge, and (5) PA waivers for patient transfers to post-acute settings. Update billing workflows and prior authorization submission procedures based on each CCO's election. Flag that these are temporary COVID-19 flexibilities and monitor for policy reversals. Verify with each payer before submitting retroactive or extended-date authorizations to avoid claim denials.